Fluconazole Prophylaxis in Children with Acute Leukemia during Induction Chemotherapy in a Tertiary Care Hospital in Bangladesh.

Abstract

Patients with hematological malignancies often develop febrile neutropenia (FN) as a complication of cancer chemotherapy. Opportunistic infection, especially invasive fungal infection (IFI) is frequently encountered during the neutropenic phase. With this perspective different anti-fungal agents had been tried as prophylaxis in leukemia. Evaluation of the role of fluconazole was as antifungal prophylaxis in children with acute leukemia during induction chemotherapy. This randomized double-blind placebo controlled prospective study was carried out in the Department of Pediatric Hematology and Oncology, Bangladesh Medical University (BMU), Bangladesh from September 2016 to August 2017. Total 60 (30 were in fluconazole and 30 were in placebo group) patients of age range from 1 to 18 years were included in this study. Mean age of the patients were 7.08±3.33 years in fluconazole group 6.29±2.79 years in placebo group. Male: Female ratio was 1.14:1. Out of total 60 patients 44 were ALL and 16 AML. Mean duration of neutropenia in fluconazole and placebo group were 13.40±5.75 days and placebo 16.83±5.77 days respectively. Success rate of fluconazole prophylaxis was 25(83.3%). Failure rates of placebo were 40.0%. Duration of empirical antifungal therapy in fluconazole and placebo group differed significantly (p=0.008). Difference of neutrophil recovery achievement in two groups was also significant (p=0.015). The mean duration from AFP to EAF therapy is 17.60±1.51 days and 14.33±5.72 days in patient with fluconazole and placebo group respectively. Prophylactic fluconazole can be used to decrease the fungal infection as well as the duration of febrile neutropenia during induction chemotherapy of Acute Leukemia in children.